DESCRIPTION (provided by applicant): Little is known about the impact of health related quality of life on the well being of Asian American (AA) breast cancer survivors. This five-year mixed-methods study entitled: "Culture, Support and Quality of Life: Asian American Breast Cancer Survivors", proposes to identify and define how culture may modify the definitions of self-integrity and quality of life (QOL) for Asian American (AA) breast cancer (BC) survivors. Each culture defines self-esteem and the proper behavior required to achieve a positive sense of self for its members, and these definitions vary. Differing cultural definitions might explain why few ethnic minorities, like AAs, use mainstream survivorship services. AABC survivors have been reported to suffer significant emotional and social problems, but European American (EA) based mainstream designed services do not seem to adequately meet their needs. Two major barriers may hinder more effective interventions. First, dissonance between the beliefs and values upon which these mainstream services are based and AA constructions of self esteem and rules for relationships may reduce the acceptability of mainstream services. For example, most mainstream services emphasize the integrity of individuality and personhood, and accordingly, address the women alone. Yet, AA culture identifies the family as the unit of analysis, not the individual. This study proposes to utilize a more holistic operationalization of culture as a concept that could establish a new avenue of research to move the science of health disparities research forward. Identification of the salient unmet cultural needs of AA women would potentially expand Western based theories of positive survivorship and provide directions to develop more culturally relevant support services to improve their QOL. Second, no consensus exists on what actually comprises the construct of culture. This study proposes to develop a more holistic conceptual framework. Therefore, our four study aims are to: 1) Characterize how women in each of the four ethnic groups define self-integrity and well-being, 2) Identify if and how ethnic specific support services address the culturally formed expectations of integrity and well-being of AA BC survivors, and how this may differ by ethnic group, 3) Explore how the breast cancer experience impacts family members, and 4) Identify the impact of the cancer experience on the women's quality of life, and if it differs by ethnicity. In-depth ethnographic interviews will be conducted with 180 BC survivors and 96 family members for all 4 Aims. We will also survey 800 BC survivors (200 from each ethnic group), and triangulate the quantitative and qualitative findings to increase the validity of our results. We will use CBPR to collaborate with our community partners, Northern and Southern CA and Houston, TX to conduct the study. The 3 sites will enable us to also assess geographic and within group cultural variations. the quantitative and qualitative findings to increase the validity of our results. We will use CBPR to collaborate with our community partners Northern and Southern CA and Houston, TX to conduct the study. The 3 sites will enable us to also assess geographic and within group variations on cultural beliefs and patterns. The outcomes of this study are likely to inform both the science and practice of survivorship in the Asian American community in particular, and among diverse ethnic populations as well, by illuminating the culturally constructed modes and outcomes for managing the cancer experience. The findings are anticipated to provide direction to better meet the needs of cancer survivors and contribute the to the elimination of health disparities.